MEDICARE: DR. THOMAS GASTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NC

General Provider Information

NPI Number	:	1114905601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS GASTON M.D.

Provider Business Mailing Address
First Line	:	548 BROOKDALE DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4108
Country	:	US
Telephone Number	:	704-872-6122
Fax Number	:	704-872-7027

Provider Business Practice Location Address
First Line	:	557 BROOKDALE DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-838-5166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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